Objective To observe and analyse the application effect and value of problem based learning (PBL) combined evidence-based learning (EBL) in emergency medicine clinical teaching.Methods A total of 53 clinical medicine students were selected.The combined teaching method was applied in emergency clinical teaching.After the end of the teaching,the teaching effectiveness survey and theory test of the combined teaching group was performed,and the theory test scores was compared with the traditional teaching group.Results The combined teaching method could stimulate learning enthusiasm,improve learning efficiency,the abilities of selfstudy,literature retrieval,and the ability to analyze and solve problems.77.4％ of students thought this new teaching method had good application value in clinical teaching.Furthermore,the excellent rate of the theory test scores combined teaching group was better than traditional teaching group (41.5％ vs 15.6％,x2 =7.868,P =0.007).Conclusions The PBL joint EBL pedagogy can overcome diadvantages of tradional teaching and provide higher interest,ability of self-study as well as higher teaching quality of the medical students.It will be worth to spread in medical clinical teaching.

Objective To compare the effect between computer assisted navigation total knee replacement and conventional total knee replacement on rotation alignment,mechanical axes,comPOnent position and clinical outcomes.Methods Eighty-two patients were recruited into this pmspoctive study according to entry criteria and were randomly selected into either control group which treated with standard knee replacements or navigation assisted group which operated with navigation assisted total knee replacements.To analyze the rotation of the femoral component and the tibial component in the transverse plane.the combined rotation of both components and mismatch between two components,the mechanical axes,which were measured from postoperative radiographs and computed tomography images.To compare the functional outcomes at 6 weeks and 6 months.Results There were significant diffefences(P＜0.05)in following parameters between control group and navigation assisted group:average rotation of femoral component were 1.51°±3.55°in control group and-0.63°±3.04°in navigation assisted group,the combined rotation of both components were 2.85°±4.07°in control group and 0.28°±3.43°in navigation assisted group,mismatch between components were 1.44°±4.55°in conlrol group and-0.43°±2.86°in navigation assisted group.There were no significant differences between two groups in rotation of tibial component.In addition,analysis showed that patients in navigation assisted group had significantly better mechanical axes and functional outcomes at 6 weeks.Conclusion The use of navigation can help avoid malrotation and errors in axial rotation,and provides improved alignment accuracy as well as better functional outcomes at 6 weeks.

Traumatic coagulopathy is a serious complication of tissue damage caused by trauma.In clinic,it easily develops into multiple system organ failure and results in high mortality.Traumatic coagulopathy is a plurality of blood coagulation disorder,its pathogenesis is extremely complex and involves tissue damage,blood coagulation,anticoagulation and fibrinolysis,inflammation and many other pathophysiological aspects.An in-depth study on the pathogenesis of traumatic coagulopathy is very important to improve clinical effect.This paper tries to do a review of recent study progress from pathophysiological mechanisms and hopes to provide reference for clinical work.

Tumor occurrence and development is a complicated process.Previous studies confirm that DNA mutations result in activation of downstream pathways of tumor cells.Recently,studies of post-translational modifications showed that RNA editing play an important role in transcriptional mechanism.Thus,RNA editing further enrich the diversity of RNA and protein,participate in the process of many diseases,including cancer.Recently,many studies have focused on the RNA editing enzymne ADAR1 because of the complexity role in tumorigenesis and progression.This article mainly reviewed the role of ADAR1 in the occurrence and development of tumors.

Objeetive To investigate the effect of TURP on the quality of life of elderly PCa patients with LUTS symptoms.Methods A retrospective analysis of the clinical data from January 2012 to January 2014 of 75 patients admitted to our hospital after prostate puncture biopsy and pathological diagnosis of PCa in elderly patients,mean age (79 ± 7) years old,which 44 cases were associated with different degrees of LUTS symptoms,of which,20 underwent TURP.After the rule of endocrine therapy,we observe and record of patients before and after treatment and 3,12,6 months after the IPSS and QOL score,compared with the changes in the quality of life of patients.Results Forty-four cases of patients with IPSS score in treatment group after 3,6 and December were (6.25 ± 2.53),(5.15 ± 2.25),(5.00 ± 2.36).Compared with the preoperative IPSS basal value (30.55 ± 3.62),the difference was statistically significant (P ＜0.01).However,there was no significant difference in the postoperative patients (P =0.209,0.863,0.154).The QOL score of treatment group after 3,6 and 12 months were (1.35 ± 1.14),(0.85 ± 0.75) and (0.70 ± 0.87).Compared with the preoperative QOL basal value (4.70 ± 0.73),the difference was statistically significant (P ＜ 0.01).However,there was also no significant difference in the postoperative patients (P =0.078,0.023,0.593).Compared with the control group of IPSS and QOL score,there was no significant difference before treatment in the treatment group (F =0.105,P =0.747),however,there was significant difference after treatment(P ＜ 0.01).Conclusions TURP is a safe and effective method to improve the quality of life and improve the quality of life of patients with prostate cancer.

Objective To systematically review the efficacy of hypotensive resuscitation for traumatic-hemorrhagic shock.Methods Randomized controlled trails (RCTs) or quasi-Randomized controlled trails (qRCTs) were searched in Pubmed,Embase and the Corchrane Library from inception to August 2015.Two reviewers respectively picked out the useful data and performed quality evaluation.Metaanalysis was carried out with RevMan 5.3 software,risk ratio (RR) and its 95％ confidence interval (CI) were pooled to estimate the enumeration data,and GRADE 3.6.1 software was used to rate the level of evidence.Results The results of meta-analysis and GRADE rating system which included 4 studies showed that:compared with conventional resuscitation,hypotensive resuscitation was associated with lower total mortality [RR =0.77,95％ CI:0.62-0.95,P =0.01;n =984,GRADE rating:moderate],and 24-hour mortality [RR =0.47,95％ CI:0.24-0.91,P =0.03;n =281,GRADE rating:moderate],but the subgroup analysis of total mortality showed that there were no significant differences in mortality between the subgroup of blunt or penetrating trauma and the subgroup of penetrating trauma.Conclusions Hypotensive resuscitation reduced total mortality and 24-hour mortality,and the quality of the evidence was moderate.The future studies should do further research to explore the efficacy of hypotensive resuscitation for different types of trauma.

Colorectal cancer is currently the third most common cancer worldwide,and there are still half of the patients undergoing recurrence and metastasis after surgical treatment,so it is necessary for colorectal cancer patients to receive radiation therapy routinely.Due to the side effects brought by radiotherapy,it is of great importance to solve how to minimize the radiation dose in radiation therapy and improve radiation sensitivity.In recent years,people discovered that microRNAs can not only be involved in the origins of colorectal cancer and progress,but also play a increasingly important role in cancer radiosensitivity.MicroRNAs can regulate tumor radiosensitivity by influencing tumor microenvironment and function on target genes.DNA damage response caused by radiation includes the activation of ATM,histone modification and chromatin remodeling,cell cycle arrest,damage repair and apoptosis.microRNAs can regulate tumor radiosensitivity through above processes.This review focuses on the mechanism of microRNAs in affecting DNA damage repair and prospects the future of microRNAs in influencing the sensitivity of cancer radiotherapy in clinical application.

OBJECTIVEThe purposes of this study were to clone and sequence the major histocompatibility complex type I (MHC I) molecular antigen recognizing gene (H-2Kk) of 615 mice, and to provide the functional gene for transgenic therapy.

METHODSThe 1.4 kb full-length fragment of H-2Kk gene complementary DNA (cDNA) was amplified from the total RNA of 615 mouse liver by using reverse transcription polymerase chain reaction (RT-PCR). The cDNA was inserted into PGEM3Zf(+) vector directionally, and the competent E. coli JM109 was transformed with the ligated product. The recombinant PGEM3Zf(+)-H-2Kk cDNA plasmid was obtained using restricted enzyme analysis of the transfectants. The complete sequence of 615 mouse H-2Kk cDNA was determined by using Sanger's method.

RESULTSThe sequences of 615 mouse H-2Kk cDNA were 99% similar with those of H-2Kk cDNA which were reported by other researchers, and the sequences encoding antigen recognizing regions (ARS) were identical with each other.

CONCLUSIONThe authors cloned the MHC I molecular antigen recognizing gene (H-2Kk) of 615 mice successfully and got the functional gene of MHC I.

Animals ; Cloning, Molecular ; DNA, Complementary ; genetics ; Escherichia coli ; genetics ; Genes ; genetics ; Genes, MHC Class I ; genetics ; Genetic Therapy ; H-2 Antigens ; genetics ; Mice ; Mice, Inbred C57BL ; Point Mutation ; Sequence Analysis, DNA ; Transgenes

Six steroidal saponins were isolated from the n-butanol extract of 90% ethanol extract of the aerial parts of Paris polyphylla var. yunnanensis by silica gel for column chromatography, MCI column chromatography and preparative high performance liquid chromatography (HPLC). According to the physicochemical properties and spectral data, they were identified as 26-O-β-D-glucopyranosyl-kryptogenin-3-O-α-L-rhamnopyranosyl-(1→4)-α-L-rhamnopyranosy-(1→4)-[α-L-rhamnopyranosyl-(1→2)]-β-D-glucopyranoside (1), dioseptemloside G (2), polyphylloside III (3), chonglouoside SL-19 (4), protodioscin (5), chonglouoside SL-5 (6). Among these, compound 1 was a new compound, and compound 2 was obtained from Paris plants for the first time. The platelet aggregation activities and cytotoxicities of the above compounds were evaluated. The results showed that none of the isolated compounds showed significant platelet aggregation activity; compound 2 and 4 exhibited strong cytotoxicity against human colon adenocarcinoma cell line HT29.

Objective Gambogic acid ( GA) can suppress the growth of multiple tumor cells , including gastric carcinoma , hepatoma , hematologic neoplasms and breast carcinoma , but there have been few reports about its effect on urologic neoplasms .This study was to investigate the possible mechanisms of GA inducing bladder cancer cell apoptosis and cell cycle arrest . Methods We cultured human bladder cancer BIU8-7 cell lines in vitor and treated the cells in the logarithmic growth phase with isotonic saline solu-tion (negative control)or GA at the concentrations of 1.0, 2.0, and 3.0μmol/L, respectively.We determined the expression of the Caspase-3 protein in the tumor tissue using the immunohistochemical S-P method and detected GA-induced apoptosis of the bladder cancer cells and cell cycle changes by flow cytometry . Results The expressions of the Caspase-3 protein were 4.28 ±1.86, 5.03 ± 0.78, and 6.47 ±1.31 in the 1.0, 2.0, and 3.0μmol/L GA groups, respectively, significantly higher than 2.13 ±1.27 in the nega-tive control (P<0.05).Flow cytometry showed a gradual decrease of the cells in the G 0/G1 phase and a gradual increase in the G2/M phase , but no obvious change in the S phase . Conclusion Gambogic acid can promote the apoptosis , arrest the cell cycle , and in-hibit the proliferation of bladder cancer cells by increasing the expression of the Caspase -3 protein.